A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height; further:
- Inspection (viewing).
- Skin and mucous membranes [lymphedema due to lymph node metastases; anemia (anemia)]
- Inspection and palpation (palpation) of the abdomen (belly), inguinal region (groin region; examination for inguinal lymph nodes!), etc. (pressure pain?, knock pain?, release pain?, cough pain?, defensive tension?, hernial orifices?, kidney bearing knock pain?)
- Inspection and palpation of the genitals (penis and scrotum); assessment of
- Pubescence (pubic hair), of the penis (penile length: between 7-10 cm when flaccid; presence of: Indurations (tissue hardening), anomalies, phimosis/foreskin stenosis?)
- Testicular position and size (if necessary by orchimeter); if necessary, the painfulness compared to the opposite side or where is the punctum maximum of pain.
- Digital rectal examination (DRU)* : Examination of the rectum (rectum) and adjacent organs with the finger by palpation (assessment of the prostate in size, shape and consistency, detection of indurations (tissue hardening) if necessary). [Typical findings in prostate cancer are:
- Firm consistency (“wood hard”).
- Irregular or bumpy surface
- Circumscribed indurations (hardening of tissue).
- No delimitability to neighboring structures
- Differential diagnoses: benign prostatic hyperplasia (BPH; benign prostatic enlargement); chronic prostatitis (prostatitis); granulomatous prostatitis – prostatitis with formation of granulomas (tissue nodules) after secretion congestion; prostatic abscess (collection of pus in the prostate gland); prostatic stones]
- Inspection (viewing).
- Health check (as an additional follow-up measure).
Notes on digital-rectal examination *
- Based on data from the “Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial” (PLCO)”, the impact of digital-rectal examination (DRU) on the detection of clinically significant prostate cancer in men ≤ 75 years of age is low: more than 1,000 men must undergo rectal palpation to find clinically significant prostate cancer.
- Follow-up analysis of the PLCO* study:
- Men with a positive DRU were twice as likely to develop clinically relevant prostate cancer as men who were consistently unremarkable on DRU during the early years.
- Men with normal PSA levels (defined as <2 ng/mL) and.
- Men with intermediate PSA levels (2-3 ng/ml) and.
- Negative DRU developed prostate cancer in ten years 3.5%.
- Positive DRU developed in ten years 6.5% of a prostate carcinoma
- Men with elevated PSA levels (> 3 ng/ml) and.
- Negative DRU developed 14% prostate cancer in ten years.
- Positive DRU developed in ten years 23% of a prostate carcinoma
- Systematic review and meta-analysis: The pooled sensitivity of DRU (percentage of diseased patients in whom disease is detected by use of the procedure, ie. a positive finding occurred) performed by primary care physicians was 0.51 (95% CI, 0.36-0.67; I2 = 98.4%), and the pooled specificity (probability that actually healthy individuals who do not have the disease in question are also detected as healthy by the test) was 0.59 (95% CI, 0.41-0.76; I2 = 99.4%). The pooled PPV (positive predictive value) was 0.41 (95% CI, 0.31-0.52; I2 = 97.2%), and the pooled NPV (negative predictive value) was 0.64 (95% CI, 0.58-0.70; I2 = 95.0%). The quality of evidence assessed by GRADE (Grades of Recommendation Assessment, Development, and Evaluation) was very low.
* PLCO: Prostate, Lung, Colorectal and Ovarian.
Square brackets [ ] indicate possible pathologic physical findings.